Fighting Depression with Everything You’ve Got
May 14, 2009 · Posted in EMDR, Mental Health, Therapy · Permalink

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Anyone who has felt the leaden weight of depression for any amount of time can only have the greatest empathy for Daphne Merkin, as she bravely writes about her lifelong battle with depression in “A Long Journey in the Dark”, the cover story for the New York Times Magazine (May 10). I approached reading the article assuming it would be moving and honest. I have been a fan of her writing for years. But as I read the article I found myself feeling annoyed and then angry about two things. One is her implication that electro-convulsive therapy be avoided at all cost.  The other is the narrowness of large swathes of the psychoanalytic community.

As a therapist and as a friend I have seen absolutely miraculous recoveries from intractable depression with ECT. The idea that ECT is the treatment of last resort and a shameful capitulation to a barbaric practice is just dead wrong. Merkin has her right to her own fears and biases, but when I reading her dramatic and sensationalistic imagery I winced imagining a client of mine reading the following paragraph.

“What if ECT would leave me a stranger to myself, with chopped-up memories of my life before and immediately after? I may have hated my life, but I valued my memories-even the unhappy ones, paradoxical as that may seem… The cartoonish image of my head being fried, tiny shocks and whiffs of smoke coming off it as the electric current went through, haunted me even though I knew that ECT no longer was administered with convulsive force, jolting patients in their straps.”

This is what keeps ECT recipients from sharing their success stories with others and from feeling proud about taking a very big step to heal themselves despite all the negative judgements.  Merkin may be able to take months to either recover or languish because of financial security, a free-lance career and only one 17 year old daughter but other people have young children to raise, jobs to do, and bills to pay. They can’t afford to take months of being in a “neuro-vegetative” state.  Merkin just set ECT back years in that one article.

My second negative reaction (that is an understatement) to the piece came when she described her therapist, “a modern Freudian analyst whom I had been seeing for years and who had always struck me as only vaguely persuaded of the efficacy of medication for what ails me.”

This is what gives psychoanalytic talk therapy the image of being self-indulgent and not that helpful to many. Helloo, Mr Analyst! You are her guide in treatment. If you are dubious about using medicine for depression you haven’t done your homework. Have you then recommended that she do EMDR (trauma processing therapy), cognitive-behavioral therapy, dialectical behavior therapy, meditation, somatic experiencing, neurofeedback, yoga or a combination of these treatments? Have you read and studied about all the incredible brain research that is out there? Or have you just rested on the elitist, narrow notion that any alternative or modern therapeutic modality is “below” the standards of analysis? Sure, I remember thinking that way because that’s what I was taught thirty years ago, too.

One should evolve as a therapist. Would a heart patient visit a cardiologist who utilized only techniques they were taught in medical school thirty years ago? No – they would choose a doctor with a breadth of knowledge, whose methods are completely current. A therapist should build on what they know. And what we know is that are an array of well-researched therapeutic tools to treat depression that can work in conjunction with the traditional forms of talk therapy. If I had been honored to be consulted by Daphne Merkin, that is what I would have said.

Now, I could be wrong. Merkin’s therapist may have suggested all of these things to her. And she may have tried them all and still have been left with paralyzing depression and a strong impulse toward suicide. But I bet it’s not true. I have heard story after story with individual and couples who endure ten, fifteen, thirty years of treatment without the transformative results that are the goal of therapy.

Here’s bottom line. If your client is not getting better, bring in other professionals, research other modalities – get more effective help for him or her. If ECT is really called for, consider helping to reduce their fear by escorting your patient — get out of your comfort zone.

Almost everyone I know, myself included, has felt the weight of depression or anxiety. It seems to be a big part of the human condition now. Fighting depression is an everyday battle for some of us, and we should use all the tools at our disposal.

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Comments

  1. Anonymous
    May 14th, 2009 | 7:52 am

    I too was appalled by the article for the very same reasons. It sounded like something out of the 50’s. I don’t think she mentioned even once that ECT is now done with anasthesia. In an effort to feel better wouldn’t you want to try every avenue possible? In addition there are tons of studies out there that have proven that talk therapy alone does have an effect and that it should continue while taking meds. Hopefully anyone reading that realizes that there is so much more research and information out there than what was indicated in that article.

  2. Pam
    May 14th, 2009 | 1:39 pm

    I feel so fortunate to live in a time when I can take medication for my depression without being debilitated by side effects. Without it, all of my energy would go to managing my depression, irritation, anxiety. With it I am a better parent, wife, and individual. I would never diminish the value of any treatment that can give someone her life back. There is no valor in suffering when there are safe and effective ways to alleviate the pain.

  3. KCF
    May 15th, 2009 | 10:56 am

    As the daughter of a woman who was absolutely saved by ECT (and that was 40 years ago!), I agree completely with your point of view here. The article was disappointing.

  4. Veronica
    May 20th, 2009 | 3:18 pm

    i didn’t realize ECT was really used anymore. After reading this post I went and read Merkin’s article and felt very sorry for her daughter. I would like to think I would do ANYTHING to feel better and take care of my daughter.

  5. Carolina T
    June 3rd, 2009 | 8:14 pm

    I really liked that article actually. I didn’t think about ECT part until I read the post. It makes sense, but I still think it was brave of Merkin to write about her depression.

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